A Scoping Review of Indicators for Sustainable Healthy Diets

Introduction: Diets are currently unsustainable in many countries as evidenced by the growing burden of malnutrition, degradation of natural resources, contributions to climate change, and unaffordability of healthy diets. Agreement on what constitutes a healthy and sustainable diet has been debated. In 2019, FAO and WHO published the Sustainable Healthy Diets Guiding Principles, defining what qualifies as a sustainable healthy diet. While valuable, these principles require measurable indicators to support their operationalization. Our scoping review aims to describe how sustainable healthy diets have been assessed in the literature since 2010.Methods: A search for English-language articles published in peer-reviewed journals was conducted from January 2010 through February 2020 across three databases. Out of the 504 articles initially identified, 103 articles were included. Metadata were extracted from each article on: publication year, country of study, study aims, methods, main data sources, indicators used to assess sustainable healthy diets, reported indicator strengths or limitations, and main study findings. A qualitative content analysis identified major conceptual themes across indicators and their frequency of use.Findings: From the 103 empirical articles included in our review, 57.3% were published after 2017. Most studies were carried out in high-income countries (74%). Approximately 42% of the articles assessed the sustainability of diets using solely health and environmental indicators; <25% assessed the sustainability of diets across health, environmental, and sociocultural aspects of sustainability. We found a substantial number of unique indicators used for assessing health (n = 82), environmental (n = 117), and sociocultural (n = 43) aspects of diets. These indicators covered concepts related to health outcomes, aspects of diet quality, natural resources, climate change, cultural acceptability, and cost of diets. The preponderance of indicators currently used in research likely poses challenges for stakeholders to identify the most appropriate measures.Conclusion: Robust indicators for sustainable healthy diets are critical for understanding trends, setting targets, and monitoring progress across national and sub-national levels. Our review highlights the geographical imbalance, the narrow focus on health and environmental aspects, and the lack of common measures used in research. Measures registries could provide the decision-support needed by stakeholders to aid in the indicator selection process.

Vegetables for Healthy Diets in Low- and Middle-Income Countries: A Scoping Review of the Food Systems Literature

Background: Vegetables are an essential element in healthy diets, but intakes are low around the world and there is a lack of systematic knowledge on how to improve diets through food system approaches. Methods: This scoping review assessed how studies of food systems for healthy diets have addressed the role of vegetables in low- and middle-income countries. We apply the PRISMA guidelines for scoping reviews to narratively map the literature to an accepted food systems framework and identify research gaps. Results: We found 1383 relevant articles, with increasing numbers over 20 years. Only 6% of articles looked at low-income countries, and 93% looked at single-country contexts. Over half of articles assessed vegetables as a food group, without looking at diversity within the food group. 15% looked at traditional vegetables. Issues of physical access to food were among the least studied food system topics in our review (7% of articles). Only 15% of articles used a comprehensive food system lens across multiple dimensions. There is also a research gap on the impacts of different policy and practice interventions (13% of articles) to enable greater vegetable consumption. Conclusions: Food system studies necessarily drew on multiple disciplines, methods and metrics to describe, analyze, and diagnose parts of the system. More work is needed across disciplines, across contexts, and across the food system, including understanding interventions and trade-offs, and impacts and change for diets particularly of marginalized population groups. Filling these gaps in knowledge is necessary in order to work toward healthy vegetable-rich diets for everyone everywhere.

Experiences and Lessons from Agri-Food System Transformation for Sustainable Food Security: A Review of China’s Practices

Food system transformation has been a widely discussed topic in international society over time. For the last few decades, China has made remarkable achievements in food production and has contributed greatly to the reduction in global hunger and poverty. Examining experiences and lessons from China’s food security practices over the years is helpful to promote a national food system transformation for China, as well as other developing countries. This study systematically reviews the literature on Chinese food security studies, with the aim of assessing China’s food security achievements and examining the remaining and emerging issues in the pursuit of food system transformation. The results show that China has continuously promoted food system transformation in land consolidation, agri-food production technologies, management and organization modes, food reserves, trade governance, and food consumption. These transformations ensure not only food availability, timeliness, and nutrition, but also in terms of the ecological, social, and economic sustainability, feasibility, and justice of food security. However, China is also confronting new challenges in food security, for example, malnutrition, environmental unsustainability, and reductions in diversified agri-food. In the future, China is expected to be committed to promoting healthy diets, sustainable agricultural production, climate change mitigation, and the reduction of food waste and loss to enhance its agri-food system’s resilience.

Dietary Intake, Cost, and Affordability by Socioeconomic Group in Australia

Few Australians consume diets consistent with the Australian Dietary Guidelines. A major problem is high intake of discretionary food and drinks (those not needed for health and high in saturated fat, added sugar, salt and/or alcohol). Low socioeconomic groups (SEGs) suffer particularly poor diet-related health. Surprisingly, detailed quantitative dietary data across SEGs was lacking. Analysis of the most recent national nutrition survey data produced habitual intakes of a reference household (two adults and two children) in SEG quintiles of household income. Cost and affordability of habitual and recommended diets for the reference household were determined using methods based on the Healthy Diets Australian Standardised Affordability and Pricing protocol. Low SEGs reported significantly lower intakes of healthy food and drinks yet similarly high intakes of discretionary choices to high SEGs (435 serves/fortnight). Total habitual diets of low SEGs cost significantly less than those of high SEGs (AU$751/fortnight to AU$853/fortnight). Results confirmed low SEGs cannot afford a healthy diet. Lower intakes of healthy choices in low SEGs may help explain their higher rates of diet-related disease compared to higher SEGs. The findings can inform potential policy actions to improve affordability of healthy foods and help drive healthier diets for all Australians.

Women’s Perception of and Readiness to Adopt a Sustainable Healthy Diet: A Cross-sectional Survey in Enugu City, Nigeria

Background: Perceived benefit of and readiness to adopt sustainable healthy diets (SHDs) is under-investigated in low-resource countries. We assessed women’s perceived benefit of and readiness to adopt SHDs and their associated factors in Enugu Metropolis, Nigeria. Methods: A household cross-sectional survey of childbearing women (n = 450) was conducted in January and February 2021 using a questionnaire assessing food choice motives, perceived benefit, and readiness to adopt SHDs. Readiness to adopt SHDs was grouped into pre-contemplation and contemplation (PC/C), preparation and relapse (P/R), and action and maintenance (A/M). Results: About 79% and 60% of women have high perception and adopted SHDs respectively. Perceived benefit of SHD was associated with younger age (β = -0.20, ρ < 0.05), low education (β = -0.19, ρ < 0.05), and poor wealth quintile (β = -0.57, ρ < 0.001). PC/C was predicted by low perceived benefit (OR = 10.07, 95% CI: 4.78-21.22, ρ < 0.001), low education (OR = 2.51, 95% CI: 1.25-5.04, ρ = 0.010), and taste (OR = 3.96, 95% CI: 1.61-9.75, ρ = 0.003). PR was predicted by low perceived benefit (OR = 3.92, 95% CI: 1.99-7.73, ρ < 0.001), low education (OR = 1.82, 95% CI: 1.00-3.29, ρ = 0.049). A/M was related to younger age (OR = 0.48, 95% CI: 0.27-0.84, ρ = 0.010, PR), and health (OR = 0.14, 95% CI: 0.06-0.36, ρ < 0.001, PC/C) and (OR = 0.17, 95% CI: 0.08-0.35, ρ < 0.001, P/R). Conclusions: Adoption of SHDs need to improve in Enugu, Nigeria. We identified the factors that should inform dietary guidelines and campaigns to increase women's adoption of SHDs.

Vegetables and Fruit as a Reservoir of β-Lactam and Colistin-Resistant Gram-Negative Bacteria: A Review

Antibacterial resistance is one of the 2019 World Health Organization’s top ten threats to public health worldwide. Hence, the emergence of β-lactam and colistin resistance among Gram-negative bacteria has become a serious concern. The reservoirs for such bacteria are increasing not only in hospital settings but in several other sources, including vegetables and fruit. In recent years, fresh produce gained important attention due to its consumption in healthy diets combined with a low energy density. However, since fresh produce is often consumed raw, it may also be a source of foodborne disease and a reservoir for antibiotic resistant Gram-negative bacteria including those producing extended-spectrum β-lactamase, cephalosporinase and carbapenemase enzymes, as well as those harboring the plasmid-mediated colistin resistance (mcr) gene. This review aims to provide an overview of the currently available scientific literature on the presence of extended-spectrum β-lactamases, cephalosporinase, carbapenemase and mcr genes in Gram-negative bacteria in vegetables and fruit with a focus on the possible contamination pathways in fresh produce.